Different kinds of myopia, which one is yours?
CONGENITAL MYOPIA – It is the myopia of the newborn, mainly those who are born with low weight or are premature babies (“20% of preterm infantas suffer from myopia; as the greater the degree of prematurity is, the level of myopia is higher, reaching 8 to 10 diopters, according to a study by the International Center of Optometry –IOC-”). This myopia persists in the childhood, and remains when the school stage begins (6 years) (2%). It is not usually a low myopia degree and as time goes by, it will increase.
ACQUIRED MYOPIA -
Myopia caused in the youth – This myopia appears between 6 and 12 years old. This percentage increases from 2% at 6 years old to 20% at 20 years old :-O
Usually, it is a low myopia degree (-0.50 diopters or more), mainly if it appears from the age of 12. Normally these myopia will decrease, turning into emmetropia or even hyperopia in adult age.
Myopia of young adult person – This appears between 20 and 40 years old, as well in low degree, but the prevalence increases up to 30%. As the previous one, this myopia will decrease too, turning into emmetropia or even hyperopia at the last stage of the life.
These two last myopias are low and they are usually due to environmental factors (*), as for instance, excessive near-point visual activities or bad conditions of visual hygiene at school/home/work/… These myopias may increase but they will not do it in high degree.
Myopia at the beginning of the maturity – This appears from the age of 40-50 years old and the prevalence increases gradually at the last years of the life. It is the case of those people that when reaching this age, say they do not have any problem at reading a book unlike their friends of the same age. The reason is that this myopia is usually associated with the changes of the density of the ocular structures, typical of the age. When the density changes, the “refractive index” of these structures changes too, and therefore, as well the power of the whole ocular optic system. This kind of myopia is directly associated with the development and the progression of Cataracts. At a first stage myopia may be compensated through eyeglasses, but if the cataract keeps on going the natural course, the last step is surgery.
NOCTURNAL MYOPIA or NIGHT MYOPIA – It becomes apparent just in low light conditions when we want to look at a distant object. It may affect any people (myopic or not), mainly young people, and even if daytime vision is normal. Its value is usually -0.50 diopter, but may reach even -1.00 diopter in extreme cases, and in myopic people may increase the refraction at the same proportion.
This myopia is due to a disruption in the “accommodation process” (briefly, accommodation is the ability of our eyes in order to focus on different distances – I will write more about it in another later post -). When we look at distant object, accommodation does not work, so, it must be totally relaxed; but for that to happen, we need to see all details of the object so a clear image is achieved in the retina. If the light decreases, it is more complicated to see those details; so accommodation, in an attempt to clear the image, starts to work and focuses on an intermediate distance that it is not really where the object is.
Besides this, when the light decreases, the pupil is dilated (increases its size) in order to allow more light to get into the eye. But when the pupil diameter increases, the “depth of focus” (**) decreases and spherical aberrations of the visual system increase.
Because of all the previous, this nocturnal myopia is more noticed when we drive at night, since we need to see well, and we feel some insecurity behind the wheel because of this reduced vision that this myopia causes.
A little myopia of just -0.50 diopter is equivalent to losing around 15% of visual acuity, which is enough to make nocturnal driving difficult.
In the case of a emmetropic person (without refraction on daytime conditions) or a myopic person, both may solve the problem by wearing eyeglasses that correct this myopia in those conditions; in the case of the low hyperopic person, sometimes, she may remove her eyeglasses in order to drive at night and feel better; but in many occasions, the performance of some visual exercises focused to use that accommodation correctly, avoids the use of those “extra-glasses”.
Here you have an interesting article, that I encourage you to read (though it is written in Spanish) “The drivers visual acuity is reduced 70% at night”
PSEUDOMYOPIA – During many years, the progression of myopia has been researched, but nowadays there are few specific findings; as the factors are not very clear, neither what happens in the eye when the myopia increases.
Some people that say when a myopic person performs near work for a long time and a prolonged accommodation is made, a strain is carried out in the vitreous camera (9), that causes an increase of the axial length of the eye; this is why the image is not focused on the retina, but in front of it and this causes an increase of myopia.
In the other hand, others say this progression is due to a “ciliary spasm” because of a prolonged accommodation: the tonicity of ciliary muscle increases until that in a certain moment, this muscle can not get totally relaxed in order to allow seeing at distance. It is like when you take a very heavy object, and keep it strongly with your arms during some specific time, although that involves a great effort. When you let the object go, you are not capable of stretching your arms, they are rigid in that position; it is what you call “the muscle is spasmodic”. That is why, when myopia appears, or initially increases, the patient usually complains that distance vision is blurred after working at near a prolonged time, but after some minutes the vision is clear. This is called “pseudo-myopia” or “false myopia”; a real myopia does not allow that after any short time, distance vision improves. When this pseudo-myopia begins to become evident, the degree is only -0.50 to -1 diopter, this is the reason why if we can not avoid it, the best thing would be for you to receive visual therapy in order to relax that muscle, and teach your eyes to work at near without the effort that favors the increase of myopia. Thereby, we avoid that myopia to be irreversible and lastly, that an increase of the eye axial length is made, leaving myopia already structured.
MAGNA or PATHOLOGICAL MYOPIA – They are very high myopias (more than -10.00 diopters). These people should encourage periodic eye checks, since they may suffer complications as cataracts, glaucoma, retinal detachment (sudden and abundant floaters) or vitreous detachment, or macula pathologies.
(*) Factors that cause myopia
If you have always asked what you could do in order for you and your children to avoid having myopia, or even to avoid that the myopia that you already have, increases, I am so sorry tell you it is very difficult to achieve it :-(
This is because the factors that cause the myopia and its progression are nowadays a very controversial subject and have carried out much research, without finding out exactly which is the main factor: whether the hereditary character, the environment factors or both of them.
We are more worried about the progression of myopia than of any another refractive error, because, as I wrote before, although only a 2% of the children that start school suffer from it, this percentage increases very much during school stage, and also its progression is very fast during the later years. In the case that the myopia appears in adult stage, the progression is slower, but unlike other ametropias, once the myopia begins, the progression is sure. This might mean that exists an environment influence in this progression.
(**) DEPTH OF FOCUS: Until now, I had explained that in order to see an object clear, its image had to be just in the retina (fovea), but that is not totally correct. A small MARGIN is accepted, in front and behind of the retina, where the image of the object that we see, can be located, without losing clarity; this is called “depth of focus”.
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Wednesday, January 28, 2009
Refractive disorders: Myopia or Nearsightedness (1). Vision and Symptoms
As I wrote two posts ago, myopia is the best known refractive disorder worldwide. And that’s why, I have many things to tell you about this, so, I will need more than one post…
Myopic person’s vision
The typical complaint in myopia is “BLURRED VISION WHEN TRYING TO VIEW DISTANT OBJECTS”.
DISTANT vision:
Therefore, a myopic person placed next to this lamppost in Gran Via at Madrid, looking at distance, she will be able to focus (see clear) this nearby lamppost, but as her eyes look further, she will see in a blurred way more and more. Of course, it will depend on the degree of myopia or quantity of myopia that she does not wear (assessed in DIOPTERS –D-); a myopic person with a little refraction, will be able to see clear further than other that has more myopia.
CLOSE vision:
As with distance vision, this also depends on the degree of the eye refraction:
- If it is compensated (she wears corrective lenses -eyeglasses or contact lenses-), she sees well, but, in the case of a low degree myopia (lower than -3.00D), she will be doing an unnecessary effort with them. In the case of a medium degree myopia (between -3.00 and -6.00D) or a high degree myopia (higher than -6.00D), the optical effect of the lens will decrease the size of the letters very much, and she will need to bring the text very close.
- If it is not compensated, a person with low degree myopia will read without any problem and much more relaxed. In the case of a young person with a medium degree myopia, she will have to do much more effort than any person, but she will be able to do it; and an adult person with medium degree myopia or any person with a high degree myopia, she will see it probably blurred.
Appearance of myopic eye
- The nearsighted eye is usually longer than normal, because of the eye axial length is greater than normal (> 24 milimeters).
- In the other hand, the power of its lenses (cornea -1- and crystalline lens -8-) is higher than normal (cornea: >43.05 diopters and lens: 19.22 diopters), being its surfaces more curved.
According to these two features (and/or others), the image is not focused on the retina, but in a point in front of it, so that the image of the distant object (placed at 20 feet -6 meters-), is seen blurred.
Prevalence
Some data:
- In Spain, as well as in USA and UK, up to 25% of the population is myopic.
- In some Asian areas, such as China or Malaysia, up to 41% of the adult population is myopic to -1.00 dioptre and up to 80% to -0.50 dioptre.
- In Australia, the overall prevalence of myopia (worse than −0.50 dioptres) has been estimated to be 77%.
- However, in countries such as Brazil and India, the prevalence is estimated at 10% or lower.
In general, approximately a quarter of the adult population from Western Countries and 80% of children during school-age years, have myopia.
Behavior of a myopic people (symptoms)
Without wearing her refraction correction:
- She sees blurred at distance.
- A myopic person sees better at distance when squeezing the eye lids making a narrow opening.
- She can not see at distance but she does see very well at near: It is difficult for her, for instance, seeing the chalkboard at school or seeing a sign while she drives; however, she sees very well a book or the directions for using a medicine.
- She sits very close to watch television, computer or chalkboard.
- She brings the writing, reading, painting, drawing, etc., very close to her eyes; it is like if she were eating the paper or what she is looking at, mainly if the myopia is high.
- If the myopia is low, she can work at near in a more comfortable way and for more number of hours without getting tired.
That’s why, they prefer activities as reading, drawing or handicrafts, that is, any activity at near.
- They are shier and more absent-minded, since they are very “focal”, that is, they are not very aware about what surrounds them; they are able to concentrate very much and to be many hours performing a task, so that the world can fall surrounding them and they do not realize, neither whether it gets dark or not, nor whether anyone has arrived at home or not, nor whether it is already the dinner time,… This ability to concentrate (that others, as a hyperopic people, envy), acts against themselves, because, it favors the increase of the myopia, since they do not rest even to have a glass of water. This ability allows them to be good workers and to have a good school/labor performance.
- Related to all previous, they have a reduced peripheral awareness, due to as the “excessive” concentration, as well as to the close working distance that they use sometimes without realizing.
For instance, when they are reading a book, they bring it closer more and more, because, this way, the letters seem bigger. But, in one specific moment, the eye movements are not enough and they need to move their head to be able to read a whole line. If they try to get away from the text, the letters “seem smaller” (therefore, more uncomfortable for them), but the visual field increases and they are able to read faster, because they can cover a whole line just by having a look.
- Sometimes they suffer headaches (mainly in forehead and temples) or eyestrain, and sometimes, they might even squint noticeably when they are physically tired.
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Monday, December 29, 2008
Some numbers...
Extracts of the Presentation to the International Society for Geographic and Epidemiologic Ophthalmology by David Dunaway and Ian Berger (InFOCUS Center for Primary Eye Care Development).
[…] Estimates of the number of people worldwide with refractive error range from about 800 million to 2.3 billion. No prevalence data are available from the World Health Organization or from any other source relating to very large populations such as groups of nations, or whole countries. […]
[…] As for the proportion of an entire population with refractive error, Daniel Etyale of the W.H.O. reported at a special session on refractive error at an International Agency for Prevention of Blindness meeting in 2001, that 5 -15 percent of children are considered to have refractive errors, the majority of which are uncorrected, and that there is currently a need for population based studies to ascertain these figures. […]
[…] Although sufficient data have not been collected to accurately predict prevalence per diopter of correction for most populations, general prevalence information on the three types of refractive errors and of presbyopia can provide an orientation of what to expect.
- Hyperopia, for example, is usually present at birth, except in premature infants. Hyperopia decreases in magnitude through age 4 years, and the prevalence of hyperopia less than +1.25 D (an amount usually difficult to compensate accomodatively) is 4-7 percent between ages 5-20 years, remains constant through early middle age, then increases in populations aged 45 or more. […] Hyperopia also occurs in patients with poorly controlled diabetes and in patients who've had cataract surgery.
- Myopia prevalence varies with age, race and sex, increasing at least through adolescence, and is present in 1 per cent of children at age 5 years, increasing to 8 per cent at age 10 years and about 15 per cent at 15 years. Myopia occurs slightly more frequently in females than in males.
- The prevalence of astigmatism may be as high as 70 per cent, if all amounts are included, but is considered to decrease to 3 percent if the extent is limited to 1.25 diopters or more. […] If astigmatism is greater than 1 diopter, it usually develops before age 2 years.
- Not a refractive error, presbyopia is due to a loss of accommodative ability. It usually starts between ages 38-45 years and the prevalence is 100 percent by age 55. Early onset is associated with hyperopia. […]
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Refractive visual disorders. Some clarifications.
Thursday, December 11, 2008
Refractive visual Disorders. Some clarifications.
As I wrote in the previous post, when we assess somebody’s Visual Acuity and the result obtained is not 20/20, it may be, among other reasons, because of the presence of some “ametropia” also called “refractive eye disorder” or “refractive error”.
But before explaining what these words mean, first I will explain what Ocular Refraction is: it is a physical phenomenon where the light rays from the object that we look at and from the whole visual field surrounds it, when crossing certain optical structures of the eye, change their path to focus on the fovea (13) and certain points of the retina. There, these light stimuli are converted into nervous stimuli which are sent to the brain (occipital lobe) in order to convert the information from the both eyes into simple and clear image of the target and all that surrounds it.
This change of the light path is mainly due to two structures which act as lens into the eye: the cornea (1) and the crystalline lens (8) . And to a lesser extent: the aqueous humor (4) (in the anterior and posterior chamber) and the vitreous body (9) (inside of the vitreous chamber), which also influence the “dioptric power” of the eye.
Therefore, when the image of an object, placed at 20 feet (6 meters), is focused on the retina of an eye, it shows that this eye is emmetrope and its Visual Acuity (if it does not have any pathologic disorder that hampers it) will be 20/20 or better. That is, this eye does not suffer any refractive eye disorder.
But if the two following conditions are fulfilled:
- its Visual Acuity is lower than 20/20
- and it improves with the help of eyeglasses, contact lenses or another optical option,
then we can catalog this eye disorder as “Refractive Error” or “Ametropia”. This disorder is due to an upset in the power of either one of or both lenses (surfaces more curved in the case of the myopia and more flat in the case of the hypermetropia), or a change of the eye axial length (the eye is too short in the case of the myopia and too long in the case of the hypermetropia):
Grosso modo, I will now explain the refractive eye disorders, but in later posts I will explain each one of them in detail.
MYOPIA: It is the refractive error that is better known, worldwide. This prevents the distant objects to be clearly seen. In this case, optically, the light rays from the distant object (placed at 20 feet -6 meters-), are focused in a point in front of the retina, so the image is blurred.
HYPERMETROPIA or HYPEROPIA: This refractive error prevents the nearby objects, and sometimes the distant ones too, to be clearly seen. In this case, optically, the light rays from this object are focused in a point behind of the retina; so, as with the myopic eye, the hypermetropic one also sees the image blurred.
But the difference with the myopic eye is that this defect of vision is more unnoticed, and it is a defect no so well-known by people, because of the modifications that the crystalline lens can perform of its curvature, so this lens can compensate part or all of this hypermetropia ( if this is not very high) so it remains latent.
It is the most common refractive error in the newborn, because when the baby is born, the eye is not completely developed and as the body grows, so does the eyes. So, a baby with a small hypermetropia may turn into an emmetrope when she grows.
ASTIGMATISM: In the previous refractive errors, the cornea is a spherical structure (as if it was an inflated basketball that we have cut in half). However, in this defect of vision the cornea can be seen as an American football also cut in half.
Therefore, each curve in the cornea has a different dioptric power (I will better explain this concept later) and consequently, the light rays that cross each curvature suffer a different change of direction, and causing a focusing of the image on different points regarding to the retina, causing not only a blurred image but also a drop-shadow effect in the surroundings of the distant and/or nearby images. Because of this reason, the astigmatism can co-exist with myopia or hypermetropia in the same eye, but these last errors can not co-exist in the same eye at the same time.
All these refractive eye disorders cause a “faulty vision”, but in these cases this is only due to a wrong Visual Acuity. That’s why, VISION and VISUAL ACUITY are not the same concept, because we can have a value 20/20 of Visual Acuity and not being able to read the registration number of the car in front of us at 2 meters (6 feet) or keep on reading for 1 hour. Visual Acuity is only one of the different features of vision.
These “ametropias” are primary; secondarily, other refractive eye disorders may also arise:
ANISOMETROPIA: It is very strange to find a person with the same quantity of ametropia in both eyes (because we do not have two identical eyes), but anisometropia is the condition in which this difference is so big, that it is difficult that the information from the images from each eye that arrive to the brain, can be fused (I will explain this better) and can create a simple clear image.
AMBLYOPIA: It more well-known as “LAZY EYE”. This may be related to the previous disorder. I am sure some time you had seen a child wearing a patch at school or in the street, since this is one of the many ways to treat this problem (I will explain this one too).
In this case, the difference of eyeglass prescription and the functional features of one eye may be very different from the other, so one of them develops better. In this case the early diagnosis and treatment is VERY IMPORTANT.
PRESBYOPIA: Sooner or later everybody will “suffer” from this ametropia, even the person that think that, while being young, has got the best vision of the world… Sorry
This is just because of the natural aging process of human body. As time goes by we keep on losing our forces and things we could perform some years ago, now we are not capable of doing them; in vision the same fact happens too. Inside the eye, the muscle that controls the change of focus for different distances, by modifying the curvature of crystalline lens, “is more tired” too and keeps on losing flexibility, force and speed of response. As time goes by we have more difficulty for focusing more quickly and we can not see small details of nearby objects. The arms seem to stretch more and more and we would wish we’d have them longer in order to read a medicine directions for use or just a newspaper. In this case, the problem we have I resides in nearby tasks.
In the other hand, there are other disorders that also cause reduced Visual Acuity, but the difference is that this value can not be improved with any optical option, they are not refractive eye disorders but pathological disorders: Cataract, Macular Degeneration, Glaucoma ... In these cases the required treatment can not be offered by the optometrist (medicines and surgeries).
Besides there are defects of vision that are independent of the Visual Acuity value, such as, for instance: a reduced visual field, a disorder of color vision, a problem in order to focus in an efficient way when we read a book, or to work with both eyes as a team, or to discriminate shapes, or to remember what we see, or to copy something we see, or to follow a straight line… Therefore, these are not disorders of the Visual Acuity.
ILYD
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Some numbers...
Wednesday, October 29, 2008
A good vision is not only seeing 20/20
Just as “seeing” is not the same as “looking”, talking about vision it is not only enough that light focuses in a specific point of the retina in order to see 20/20, but also, vision is understanding what we see.In order to understand this concept, I will firstly explain what the words Visual Acuity mean, that many times we utilize them with our patients when we say “You have 20/20 vision“, but maybe you are not quite sure what actually that means.
When we assess the Visual Acuity test, we are assessing the ability that someone has to identify some letters or patterns from a distance where they should be seen; and the final value is the smallest symbol size than the patient is able to read from that distance.
Let me explain it better: when we perform this test, the patient must sit down 20 feet (6 meters) away from the letters chart. When we say that a person have 20/20 visual acuity (100%, 1.0 or 6/6, everything is the same), what we mean is that the person sees 20 feet away from the chart what she should actually see 20 feet away. But for instance, if that person has 20/10 visual acuity (6/3 or 0.5), that means she would only see from 20 feet what she should see from 10 feet, that is, she has 50% of vision.
Therefore, Visual Acuity is the ability to see the details of an object. But precisely because that object is not floating in the void, but furthermore, there are many more objects surrounding it, we are in a distance from that object, we may want to execute an action with it and other senses may be implicated in this action…, vision is just not only clearly seeing that object, but that many more “visual qualities” might be implicated, as we saw in a previous post .
“It is estimated that as much as 80 percent of all learning during a child’s first 12 years comes through vision”.
Because a child or an adult has 20/20 visual acuity according to a certain test, it does not mean she has good vision, since she may have problems in order to focus on a text when she reads a book, or may have bad eye-hand coordination and consequently have a bad writing, or may have some problems to how her eyes work as a team and they feel tired 10 minutes after they start a near task, or may be "clumsy" and hit herself with things because she does not calculate the distances well. In all of these examples, vision is involved and with them I only wanted to show that although we have a 20/20 Visual Acuity maybe we do not have a 100% Vision.
In many optician’s, when a person goes to check her vision, they only obtain this result and only find out the lens required to improve that percentage (whether there is myopia, hypermetropia or astigmatism), without assessing if that vision works well and if it works along with the other senses. That is, for them the goal is to obtain 20/20 visual acuity and they do not think in any other symptom that shows that it is not only important to improve Visual Acuity, but also to improve the performance working at near, or practicing a sport or reading and its comprehension. For it, as the daily problems are not always related to a visual problem, I recommend you to go to a specialized office that offers you a broader eye examination. You would be surprised of how many symptoms and problems at school can be removed by using Visual Therapy, and what this can be done to improve the quality of life in general of any person.
A child may be diagnosed with a “perfect vision” by an optician or an ophthalmologist (it doesn’t matter) simply because she has 20/20 visual acuity, but without being assessed the necessary visual skills (focusing, peripheral vision, eye-hand coordination, discrimination of shapes, spatial relations,…) required to have a correct learning or a good physical coordination. In a later post I will thoroughly explain the visual problems related with learning.
If a child is struggling with academics, sports or home behavior, parents and teachers should be encouraged to consider that a vision problem may exist, beyond a Visual Acuity.
A simple comparative example is the following one: when we read, it is not enough to verbalize what we see written and to read as a parrot, we have to understand what we see. Therefore, when we read, we must not only clearly see the letters, but we have to know, to remember, to interpret and verbalize what is written; vision process is responsible for all this.So, after all this, mi goal is for you to have a clear understanding that when you go to an office or optician’s, the Visual Acuity assessment must be ONLY a value obtained of the whole visual examination in order to achieve a precise diagnosis.
BOOK: "20/20 is not enough"
Monday, October 06, 2008
An apple a day really does keep the doctor away
This idiom is very famous, but we do not always heed this advice.
Prevention and Early Detection
Optometry basically detects visual upsets, that is, visual problems, performance problems related to vision, development problems related to vision, and so on. Therefore, if this detection is made as soon as possible, the treatment will be more effective, will need to carry out it less time and the results will be more lasting.
How can you know if you suffer any visual upset?
FROM THE FACT THAT THERE IS NO OCULAR PATHOLOGY OR ILLNESS, if you notice that you have some troubles in order to see at distance or at near (in order to read, write, draw, watch TV, drive, practice any sport, use a computer,…), this indicates that probably, you are suffering from some “refractive error” (myopia, hypermetropia, astigmatism, anisometropia, presbyopia... concepts that I will explain in later posts). These visual problems are not pathologies or eye illness, but they may cause a big discomfort performing the tasks of daily life, although they have an insignificant value.
These problems are “quantitative visual disorders”, and using a prescription (eyeglasses, contact lenses or prisms), usually they are corrected (THOUGH NOT REMOVED).
But, in the other hand, there are other “problems of quality vision” (they are not eye illness neither), that we can not be shown to the patient with understandable quantitative data, but that, however, may almost cause more frustration and powerlessness than the previous problems. This is because many people do not know very well what happened, or where they can go with their problem.
Fortunately, there are more and more optician’s shops or offices where they perform visual exams are more complete than a simple ocular refraction in order to obtain those “refractive errors”. There they detect the reason of it: a performance problem at work or at school, a learning disability, a visual development problem, a clumsiness or balance problem, an inability in order to read a book during long time, a carsick, a dyslexia, and so on. I guess that you did not imagine the great relation that there is between vision and all things that we do daily; and many times you do not realize that, by treating a problem from vision, we can solve the visual problem and the trouble that you did not know how “solve”.
What can you do if you have a visual problem?
If you have any of these problems or any other that you think that can be related to vision (if you have some question, you can consult me about it in the comments, in order to confirm if your problem is or not a visual problem that any of my colleagues may diagnose; I am sure that many people have your problem too, and if I advise you, we can help more people; but how I wrote in the welcome post, I will never give you a solution or treatment for your problem, because I would need to assess each case in an isolated way), I recommend you to visit a qualify optometrist and you ask him a comprehensive visual exam. Afterwards, he will give you the better treatment option (refractive prescription, vision therapy, reflexes therapy or rhythmic movement therapy, syntonic phototherapy... – treatments that as well I will explain at length in later posts-), or will refer you to the professional best fitted to treat your problem.
A small problem is always easier to treat than a big problem.
Monday, September 22, 2008
Identifying signs and symptoms for a visual problem
- Itching, stinging or watery eyes
- Frowns or scowls in order to seeing better
- Blurred vision at distance or at near
- Very close distance when watching TV, writing or reading a book
- Has difficulty for copying from the board
- Unusual eyestrain when finishing a task or decline in the reading after long periods
- Omission of tasks at near
- Fatigues quickly during reading, writing or drawing
- Bothered by the sun and lights changes
- Headache and eye pain
- Negative behavior at school or at work
- Bad head or body posture
- One eye drifts or aims at a different direction than the other (look carefully, this can be subtle). This is significant even if it only occurs when the child is tired or stressed
- Closes or covers an eye, or twists or tilts head, when reading and writing or watching TV…
- Double vision
- General difficulties at Reading:
- Moves head when reading instead of to move the eyes
- Words slide together
- Reading speed below chronological age
- Does not understand what he has read or does not remember it
- Loses place, skips lines or rereads words or lines
- Needs to use finger as a marker to keep place
- Reads in loud voice or moving lips
- Omits or adds words or tries to guess them from the fast recognition of one part of them
- Mixes syllables when reading and numbers in maths
- Reverse letters, syllables or words
- Avoids reading or other close-up tasks
- General difficulties at writing or in the hand’s motor skill:
- Irregular and changeable letter size
- Small spacing
- Inability to write in a straight line
- Reverses letters, words and numbers when writing or copying
- Favors the reading with regard to playing or motor activities
- Favors oral exams with regards to the written ones
- When coloring, he can not keep his work inside the lines
- Does not like to draw
- Grabs the pencil badly, or takes out his tongue or does strange gestures with his face when he uses his hand to perform something that requires eye-hand coordination
- He is slow when he has to follow a dictation
- Bumps into things
- Sometimes he appears clumsy
- Becomes easily distracted
- Has a short attention span and needs a lot of rests
- Poor concentration
- Homework takes longer than it should
- Poor visual memory
- Negative and/ or aggressive character
- Troubles for adapting to the changes
- Gives up easily (says “I can’t”, before trying)
- Dizziness, nausea or motion sickness
- Poor posture when sitting down and working
- Incapacity of being kept sat down on a chair more of 5 minutes
- Walks on tiptoe
- Balance troubles
- Confuses right and left in himself and/or in the space past age 7 (and sometimes up and down)
- Poor performance of sports or coordination of hand-eye and foot-eye (ball skills and team games): catching and hitting a ball
- Etc.
These manifestations will help you yourself to detect if any child, in your environment, may have an undiagnosed visual problem.
Moreover, in the optometric office, the professional will give you or ask you a brief questionnaire about the child, his development and his visual habits. Sometimes it is very long and tedious or even sometimes, you do not know what relation, some questions may have with the eyes or with the problem that you bring to the office; but there is not random question in these questionnaires, all of them give very important information that will help the optometrist to achieve a better diagnosis about the problem that the child has got. Therefore, even though everybody thinks that their children are wonderful and perfect, think that if you go to the office is because you suspect something, and if so, being as sincere as possible when you fill in these questionnaires is better, because the lies and half truths or half informations or underestimating the details that show where the child is not so handy, will not help; this information is the most valuable in the questionnaire.
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